Our Community Pharmacy of the Month for June is not your typical pharmacy in any sense of the word. In fact, it is a health clinic on wheels that delivers pharmacy services and screenings — an ingenious solution to the problem of serving a community in a sprawling rural area.
The community pharmacies we typically feature tend to be located in small towns ideal for local pharmacists to establish meaningful relationships with their patients. Some pharmacies we’ve featured have even been located in cities of all sizes, but still create a sense of community that keeps patients engaged while drawing in new ones.
What happens when the community can’t simply walk a few steps or drive a short distance to a local pharmacy?
Hardin County, Ohio, is a rural expanse with barriers to healthcare access that have rendered it a medically underserved area with a shortage of primary medical care health professionals. The College of Pharmacy at Ohio Northern University understood that given the county’s extensive elderly population and high poverty rates, the people of Hardin couldn’t easily get to a pharmacy or clinic. The ONU College of Pharmacy team would have to take the clinic to them.
The team was determined to do good for the people of Hardin by addressing their substantial healthcare needs and led the team to seek and obtain funding — secured in April 2015 — from the Health Resources and Service Administration for an innovative mobile clinic patient care program that provides much-needed pharmacy and healthcare services to the county’s underserved population.
Amy Fanous, the director of the HRSA-funded mobile clinic, discussed with DSN the extensive planning that went into bringing the project to fruition and what the immediate future has in store. “The desire to contribute to the local community continues to drive this project. As an institution of higher learning, it is essential that we lead the community beyond our campus borders,” said Fanous. “Common statistics demonstrated great need we wanted to further explore. In Hardin County, 14.6% of the population is older than 65 years and 28% is 19 years or younger. Thirteen percent of the population does not have health insurance, while 31% are insured through the Center for Medicare and Medicaid Services. According to the Behavioral Risk Factor Surveillance System, 19.6% of Hardin County residents rate their health as fair or poor compared with a state average of 15.3%. A number of factors are relevant to the county ranking 53rd of 88 Ohio counties in overall health outcomes and 73rd for premature death.”
Planning the mobile clinic took two years. The team did not rely solely on their good intentions, and made sure to get concrete feedback from the very community they aimed to serve. Doing so has allowed them to develop a more robust program that is better prepared to fulfill its mission and that patients can actually use and depend on.
After conducting a community health assessment in 2013, the team talked with Hardin County citizens in the fall of 2014. “These direct conversations were extremely useful because they allowed us to hear firsthand what the real health issues in our county are,” explained Fanous. “Community members told us that health issues in Hardin County included limited access for patients to physicians and other primary care providers, transportation problems accessing existing medical care providers and difficulty with understanding and managing chronic medical conditions.”
The clinic was operational by September 2015. Fanous said that the longer she spends time in the community holding consistent events at the same places, such as the food pantry or a community dinner, the more trust and rapport she builds with the people and the more patients the clinic sees. “These community relationships are essential,” she added. Trust is indeed essential to the success of any community pharmacy, and the mobile health clinic has invested the time and effort needed to establish it.
Services offered include cholesterol, glucose, hemoglobin A1c, blood pressure, bone density and skin scope screenings; United States Preventative Services Task Force screenings; immunizations; tobacco cessation; medication reconciliation; and education on a variety of health topics. All these services offered at no cost to the patient. The clinic is staffed by pharmacy residents and pharmacy students. Additionally, there are opportunities for nursing, clinical laboratory sciences, exercise physiology and students from each discipline at Ohio Northern, which provides students with authentic training and patient care experiences.
To increase access to care, the mobile clinic heads out to various locations throughout the county three to four days a week during hours convenient to the people of Hardin. The clinic sets up at churches, community buildings, businesses and schools, including the Hardin county fair grounds, the Kenton-Hardin Health Department, the Forest EMS Building, the Plaza Inn in Mount Victory, the Dunkirk EMS Building, the Roundhead Post Office, Hardin Northern Local Schools, Ridgemont Local Schools, Upper Scioto Valley Local Schools, Ada Exempt Village Schools, Ada Presbyterian Church and Ohio Northern University. “We choose locations based on community partners and those that are convenient for the patients. Keeping lack of transportation in mind, we try to cover as much of the county as possible. Our entire county is rural, but some locations are more remote than others. For instance, the Roundhead Post Office is in Roundhead Township — the entire township only had a population of 752 according to U.S. Census Data in 2000,” Fanous said.
The mobile clinic has been very well received by patients and community partners alike. In fact, the team is expecting the arrival of a new vehicle, which will allow them to cover more of the community and attract new community partners. Existing partnerships with Hardin Memorial Hospital, Kenton Community Center and the Kenton-Hardin Health Department have also expanded: Primary care and specialty providers from these places plan to head out in the mobile clinic with the pharmacy team.
Given the clinic’s success so far and the need that exists across the nation, Fanous agreed that other colleges of pharmacy could develop similar programs based on ONU’s model. “Services that improve access to care are needed in many rural communities. A mobile clinic, using a multidisciplinary team of healthcare providers and students, is an option for improving access to care,” she said. “The concept of ‘bringing health care to the people’ is feasible in many settings. Any outreach that consistently provides care for patients outside of a medical facility would serve this purpose. Periodic, rotating mobile care sites in the community that use existing facilities can easily be implemented with proper supplies, personnel and time.”
And colleges of pharmacies are in a unique position to address any potential shortage of healthcare professionals by mobilizing health profession students that need hands-on experience. “Although a workforce of professional students may not be available in all rural communities, many health professions training programs exist in states with vast rural areas,” Fanous added. “It is feasible to recruit groups of students from nearby universities, such as students on clinical rotations or outreach activities, or using a pool of healthcare volunteers to boost the workforce. Additionally, use of professional students allows the mobile clinic services to provide a dual role as a focused, high quality learning experience in addition to providing enhanced patient care.”
Fanous believes that that a better understanding of the community and its people helps create better pharmacists. “To provide care to people, you must first understand the issues they face, and you can’t gain that comprehension until you get out in the community,” she stressed. It certainly provides pharmacy students with the experience they need so they can work in whatever setting they choose once they graduate. Students also see for themselves that behind the statistics in Hardin County are real-life people with real-life problems — tapping into the humanity teaches them compassion and patience that together with their skills and experience will allow them to build their own meaningful relationships with patients. “Students also learn that every person is unique, and the way they respond as pharmacists and healthcare providers must also be unique for every situation,” Fanous concluded. “We fill needs — not prescriptions. The mobile clinic is a perfect opportunity for our students to live that mission.”
DSN thanks Fanous for talking with us and external relations coordinator Ericka Kurtz for facilitating the interview. Know a deserving pharmacy team who works hard to drive adherence? Click here to nominate them, and they'll be featured in our Drug Store News Community Pharmacy Quality and Performance Spotlight.